Summary

The individual in this position is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient�s resources and right to self-determination. The individual in this position has overall responsibility to ensure that care is provided at the appropriate level of care based on medical necessity and assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.

Responsibilities

The individual�s responsibilities include the following activities:

• Provides assistance to the Director of Case Management in the management of the department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments
• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at the appropriate level of care
• Accountable for compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Provides education to physicians, patients, families and caregivers
• Facilitates educational programs for Case Management Department on community resources use in discharge planning that encourages professional growth
• Provides reports to DCM and hospital leadership as requested The individualâ��s responsibilities include the following activities: a) assist the Director in the daily operations of the department b) accurate medical necessity screening and submission for Physician Advisor review, c) transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h) identification and reporting over and underutilization, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Tenet Case Management documentation system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of potentially avoidable days, p) and other duties as assigned.

Up to 8k Sign on Bonus available based on experience

Education

Preferred: Bachelor of Science in Nursing (BSN)

Experience

Required: Two (2) years acute hospital patient care experience.
Preferred: Acute hospital case management experience.

Certifications

Required: Active Registered Nurse license.
Preferred: Accredited Case Manager (ACM)

Candidates in unit have priority based on unit seniority.

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Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.